A patient with Wolff-Parkinson-White syndrome develops atrial fibrillation. Which of the following drugs is CONTRAINDICATED because it can paradoxically accelerate ventricular rate?
- A Digoxin ✓
- B Amiodarone
- C Procainamide
- D Flecainide
Correct answer: A. Digoxin
Explanation
In WPW with AF, digoxin is contraindicated because it shortens the refractory period of the accessory pathway (by increasing vagal tone that paradoxically enhances accessory pathway conduction), potentially accelerating conduction down the bypass tract and increasing ventricular rate, risking degeneration to ventricular fibrillation. Verapamil shares a similar concern. Procainamide, amiodarone, and flecainide are acceptable options as they prolong accessory pathway refractoriness. DC cardioversion is the preferred definitive treatment.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.